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Evaluation and Management of Dysphagia pp 63–80Cite as

Gastroesophageal Reflux Disease

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Abstract

Although neither a common nor typical symptom of gastroesophageal reflux disease (GERD), dysphagia is frequently encountered in GERD patients and should prompt evaluation for GERD complications (e.g., reflux esophagitis, peptic stricture, malignancy) or alternate diagnoses. Eosinophilic esophagitis (EoE) can overlap with or mimic GERD; primary treatment of EoE also starts with proton pump inhibitor (PPI) therapy similar to GERD. Esophageal body hypomotility is seen in especially complicated GERD, but a cause-and-effect relationship may not exist in all cases. The frequency of ineffective sequences and breaks in esophageal body peristaltic integrity on esophageal high-resolution manometry (HRM) are more common in GERD patients with dysphagia. Esophageal function testing should be undertaken in patients with suspected GERD, especially when symptoms are refractory to PPI, to evaluate for confounding motor disorders such as achalasia and other non-GERD processes. PPIs are effective for proven GERD and heal reflux esophagitis and associated dysphagia. Maintenance PPI therapy decreases the need for repeat dilation of reflux-mediated (peptic) esophageal strictures. Efficacy of antireflux surgery is comparable to PPI therapy for GERD but carries risks of post-operative dysphagia. Provocative maneuvers on esophageal HRM, barium radiography, and endoscopic functional lumen imaging probe (endo-FLIP) can complement diagnosis. If esophageal testing is completely negative and dysphagia persists, functional dysphagia is diagnosed.

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AP discloses no conflicts. CPG discloses consulting and speakers’ bureau relationships with Medtronic and Diversatek, and consulting relationships with Ironwood, Torax, and Quintiles.

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Authors and Affiliations

  1. Division of Gastroenterology, Duke University School of Medicine and the Durham Veterans Affairs Medical Center, Durham, NC, USA

    Amit Patel

  2. Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA

    C. Prakash Gyawali

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  1. Amit Patel
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  2. C. Prakash Gyawali
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Correspondence to C. Prakash Gyawali .

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Editors and Affiliations

  1. Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, TN, USA

    Dhyanesh A. Patel

  2. Center for Esophageal Diseases, University of Chicago Medical Center, Chicago, IL, USA

    Robert T. Kavitt

  3. Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, TN, USA

    Michael F. Vaezi

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Patel, A., Gyawali, C.P. (2020). Gastroesophageal Reflux Disease. In: Patel, D., Kavitt, R., Vaezi, M. (eds) Evaluation and Management of Dysphagia . Springer, Cham. https://doi.org/10.1007/978-3-030-26554-0_4

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  • DOI: https://doi.org/10.1007/978-3-030-26554-0_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26553-3

  • Online ISBN: 978-3-030-26554-0

  • eBook Packages: MedicineMedicine (R0)

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